2011-09-30

A couple of days ago, I described a potentially positive way to digest problems, using the old handy phrase "private Idaho." Well, I feel as though I have been living comfortably in my own private Idaho for the past week and I am now confronted with a new "dilemma." Once one finds oneself in Idaho, why leave?

I first conceived of the whole Idaho metaphor while staring at the back of a semi-truck in the middle of virtually gridlocked traffic conditions. The back of the truck's trailer was painted to look like a farm truck full of potatoes rolling along on a beautiful sunny day. That truck must have been rolling along at just the right moment, because I was instantly transported out of my dreary, bleak day and into the cool Autumn breeze and heady aroma of a sunny afternoon somewhere in, say, Preston, Idaho. I spent my university years in the general vicinity, and while it's not something I'd describe as "perfect," there is something about those Autumn breezes that really soothes and calms the soul.

Suffice it to say, taking myself there mentally was a great relief that day. It allowed me to "step outside of myself" a bit and take a more even-tempered look at the stressors in my life. I liked it so much, I decided to try as much as possible to keep my head in that kind of a state: cool, even-tempered, peaceful, happy, calm.

In a way, it kind of seemed like a mental vacation at the time, Yet, here I am - days later - and I don't really want to "go back." I like it in Idaho.

Then again, who wouldn't like being cool, even-tempered, peaceful, happy, and calm? Granted, it's not possible all the time, but what a great way to handle every situation you confront: with a perfectly rational, cool head and positive perspective.

Because this line of discussion is new to my blog, I'm going to act quickly and flag it immediately as a mental health strategy. Specifically, it shall henceforth be known as...

2011-09-29

One of the greatest paradoxes I have come across is the question of the existence of paradoxes. Think of it this way:

A paradox is a statement that is both true and false.

No statement can be both true and false.

So which is it?

Dictionaries neatly sidestep this issue by defining paradoxes to be statements that are seemingly or apparently self-contradictory. This would imply that we will discover, upon closer examination, that a paradox will not be determined to be self-contradictory.

Naturally, if that were true, then the statement would no longer appear or seem to be self-contradictory. It would not be a paradox.

If paradoxes cannot exist by their own definition, then can it be said that they exist at all?

The Paradox of the Heap and the Theseus' Ship paradox are two versions of the same fundamental paradox. The idea in both cases is that there is essentially an arbitrary difference between a collective concept (such as a heap, a ship, or a forest) and the individual components that define it (such as a grain of sand, the plank of a ship, or a single tree).

There is no universal number of sand grains that make up a heap, nor a critical number of "original planks" that define a single ship. Instead, we choose to perceive something as a heap, or a ship, or a forest more or less on an individual level.

We also call them "mashed potatoes," even if the total number of potatoes used to make the dish is one.

Paradoxes always come down to either a problem of definition or a problem of perception. Either the language used in our definitions is not precise or accurate enough to encapsulate what we're trying to describe, or we are attempting to describe something universally, when its definition is entirely arbitrary.

Mashed potatoes are a problem of definition because we have defined them to be plural no matter what the reality of the situation is. Forests are a problem of perception because there exists no specific number of trees such that that number of trees makes up a forest, but one fewer tree does not.

The interesting thing about paradoxes is that they are both a problem of definition and of perception. The definition can never be true, and their existence is in fact only a matter of perception.

I have provided plenty of explanations about the health care industry in the past, and I will do so in the future. After a certain point, however, one has to acknowledge that evidence simply doesn't matter to people.

If it did, people would take the national (international, really) drug shortage more seriously. Sure, you can blame it on evil profiteering, but the economic fact of the matter is that if regulations and legislation make pharmaceuticals an unprofitable industry, then companies will shut their doors and entrepreneurs will seek other means to make money.

If proof and facts were important to anyone, then my descriptions of the many failures of Canadian single-payer health care to provide me with any health care at all would move people to acknowledge the truth.

BUT CULTS DON'T CARE ABOUT EVIDENCE.
I am tired of people telling me that my experiences didn't happen. I am tired of people telling me that my evidence is beside the point. I am tired of people telling me that this failed god of government medicine really does work, and that I am merely imagining the failures. I am tired of my American readers assuming that doctors offices and hospitals in Canada look exactly the same as they do in the USA without any evidence to support this assumption. I am tired of my Canadian readers assuming that health care looks the same all over the world as it does in Canada. I am tired of people making theoretical comparisons and ignoring the words of people like myself, who have consumed health care for more than one reason, in more than one country, under more than one system.

If I am wrong, then show me the evidence, don't just give me some half-baked Cracker Jacks theory about how the poor would implode if private health care were introduced in Canada or that cancer will swallow the entire American nation unless a single-payer system is introduced.

Don't waste my time with a fantasy. I don't believe in your cult.

Members of cults believe whatever they think they are supposed to believe, regardless of evidence. There is no evidence against private, unregulated health care. There is only the belief that "some people" would die.

2011-09-27

The picture below is a portion of the Snake River, in Idaho, courtesy TrekEarth.com.

As near as I can tell, the origin of the phrase "living in your own private Idaho" can be traced to that B-52s song from way back when. I am not sure where else it could have come from. The only other references I can find out there are references to things that were inspired by that song and/or its title.

The Bad
Generally speaking, "living in your own private Idaho" is a bad thing. The imagery is especially difficult to appreciate if you have never been to Idaho. For the "average person" living in the uncomfortably densely populated regions of, oh, say California, New York, or Ontario, Idaho is a desolate patch of nothingness bereft of anything other than sagebrush. Occasionally you will see an old, abandoned, and decrepit farm shed made of weathered planks, and there are small towns peppering the state, consisting mostly of a gas station (the center of the town's universe) and a lot of houses made of aluminum siding. Beyond that, Idaho is a massive expanse of nondescript landscape - not quite prairie, not quite mountains.

To live in your own private Idaho, then, is to exist in a vacuous mental hole, spaced-out, dazed. You wouldn't be connected to reality, and you wouldn't have much to say. Lost in your own thoughts, yes, but more than that - you would be lost in completely unimportant and insignificant thoughts. You'd be truly spaced-out.

The Good
And yet, Idaho as I have described it above has precious little in common with the gorgeous waterfall and winding river set against a backdrop of gorgeous green that I have included in the text of this blog post. How on Earth could a place as beautiful as the one in that picture exist in a state so bleak, empty, and desolate?

The answer is that Idaho is more or less what you choose to make of it. While Utah and Colorado are the western states with the reputations for "great skiing," people who actually live in Utah and Colorado go to Idaho for skiing vacations. The crowds are smaller, the prices are lower, and the skiing is just as good or better.

The soft, warm, dry breeze that floats over the tips of the grass has a sort of magical sensation to it. It is the ecological equivalent of the word "solitude." There is a peace in that breeze that is difficult to find elsewhere. Sure, the breeze can be cold sometimes, or annoying if you're trying to do something. But I think the key is in simply stopping, standing where you are, and letting the breeze pass by you for a few moments as you realize where you are.

In the summertime, the landscape has a dreamy, subtle beauty. I reiterate that there is not much there, but in that sense, the aesthetic is not unlike an abstract painting, or perhaps atonal music. The minimalist backdrop ignites the creativity of the mind's eye. Beauty suddenly and truly finds its way into the eye of the beholder. One begins to perceive the subtleties of the mountain peaks in the distance, the grassy plains and patches of trees arrange themselves in virtually endless combinations.

Then, suddenly, the landscape will break apart into huge rocky spires and jutting cliffs cut by a silver-blue strand of a river. The moment you accustom yourself to the gentle, lilting landscape of Idaho, it throws you a curve. The Snake River appears, with its whitewater corridors and gushing waterfalls. A small lake peeks out from behind the base of an unknown hillside. A huge volcanic boulder appears in the middle of an otherwise completely flat plane, deposited there by some prehistoric glacier, long-forgotten.

Idaho is stunning.

The Point
The past couple of days, I have been living in my own private Idaho. Sometimes, when things aren't going quite as well as we hope, we need some sort of mental outlet to digest the negativity and make something positive of it. Faithful readers of this blog will know that I have blogged a lot about negative and positive outlets for this sort of digestion.

I would like to propose that in our own private Idahos, we are the masters who determine whether we escape into a dreadful void or into an aesthetic perfection. In any respect, it is the same place. We must always process our stress and our negativity within the confines of our own minds.

And, just as Idaho is more or less what you choose to make of it, so you get to determine for yourself how you're going to digest and dispose of your stress and negativity. Better to do it in a good way than a bad way.

Better to seek the peace of an Idaho breeze than the barren frustration of an Idaho wilderness.

2011-09-22

To every thing there is a season, and a time to every purpose under heaven.

That is Ecclesiastes 3:1. Ecclesiastes
is part of both the Bible and the Talmud, and I assume it is also an
accepted book in the Muslim tradition, as well. It is a pretty interesting part
of the whole scholarly history of JuChrIslamism. It reflects the kind of
fatalism/determinism that is typically common in Islam and Judaism, and shares
a lot in common with the pre-Platonic Greek philosophers.

Broadly, I would describe it as
the first really explicit description of what we might term the “accept all
things as they are” school of thought. Very “zen.” In that sense, it does a good job of exposing the pessimism inherent in all of these "zen" types of philosophies. If all life ends in destruction - if, as Nuno Bettencourt would say, "Life is a fatal disease" - then the best we can ever hope for is to eap out a few of life's simple pleasures as we go along, and hope for a loving celestial embrace when it's all over. This message is really depressing to me, and I reject it whole-heartedly.

Ecclesiastes in general isn’t
really my personal philosophical flavor, but it’s not all bad. In particular,
that phrase – To every thing there is a season, and a time to every purpose
under heaven. – is worth keeping in mind. Don’t try to fit a square peg
into a round hole. Do all things at their proper time, rather than attempting
to, say, take the garbage out when it’s time to eat breakfast, or cook dinner while you're doing the dishes.

You know, that sort of thing. I don't know if it's worth converting over, but it's a concept that pops up in enough different cultures and philosophies that you pretty much can't ignore it after a while.

2011-09-20

CBC reports that Canada has finally surpassed the United States of America on the Economic Freedom Index. While this isn't the big, famous Economic Freedom Index we all know and love, it is certainly a bad omen on the economic freedom front.

What is perhaps most interesting is that Canada is ranked ahead of the USA not because of an increase in economic freedom, but because it has experienced a slower rate of decline. In other words, both Canada and the USA have lower economic freedom scores this year, but Canada's is less bad than America's.

The governments of the world are bloating outwards like gluttonous blobs, swallowing all of our liberty in fat, self-important gulps.

How Does Such a Thing Occur?
It is tempting for some freedom-loving people to imagine an evil, nasty blob like "Parallax" from Green Lantern, laughing at the futility of mere mortal existence, and swallowing everything it touches in a dark cloud of destruction...

But those of us a bit more familiar with government bureaucracies know this is not the case. No, the truth is far more underwhelming than that. If freedom's greatest enemy were a force so almighty and sinister, then there would be far too much nobility attached to protecting freedom. We would never let it go.

Instead, governments steal our freedoms by assumption, or more precisely by a series of assumptions that ordinary people take for granted, and never question.

Overcoming the rapid decline of our freedom, therefore, is a simple task of questioning the underlying assumptions that steal our liberty away.

Assumption Number One: A Problem Exists
The very first assumption by which we are confronted is the assumption that there exists some underlying problem with the way society behaves, and that this problem desperately needs to be corrected by people who know better. This is the most difficult assumption to overcome, because people will often get very angry with you if you refuse to acknowledge the existence of such a problem.

Let us take for example a common bylaw in the Northeastern regions of North America: a ban on roadside advertising billboards. Those of us who live in a world full of billboards would never even consider banning them - not because we like them, but simply because the idea that they are a problem has never even occurred to us. Granted, ceteris paribus, we would all rather see beautiful scenery than brightly colored billboards.

The assumption, therefore, starts at this random imaginary choice: Would you rather look at a beautiful horizon, or a billboard advertisement? This question would never occur to you unless someone deliberately asked you. That's not because you love billboards, but rather because the question itself is entirely objectionable. Who on Earth is ever confronted with a choice between the horizon and a billboard? Nobody. When we want to view the horizon, we do so. When we want to view advertisements, we do so. There is no choice. There is no trade-off. There is no problem.

The whole "problem" is made up.

Assumption Number Two: The Proposed Solution Actually Solves the Problem
The way this one works is like so: If you don't agree with my ban on billboards, then you're some kind of corporate tool who wants to get rich at the expense of the middle class, or some unenlightened conservative idjut who buys everything he hears on Fox News.

The reason you can't argue with the accusation is because the accusation is merely a rhetorical tool that forces you to accept a false position of opposition. The debate becomes an argument about whether billboards are an issue of corporate governance versus natural aesthetics. The issue becomes convoluted before you even have a chance to process the key features of the issue.If, by happenstance, you are a conservative or libertarian person, you may even start defending the interests of advertisers!

But you never have the chance to question the highly questionable assumption that banning billboards solves the problem expressed in Assumption Number One. If there is some kind of trade-off between viewing billboards and viewing the horizon (which there never was in the first place!), does banning billboards solve the problem?

Well, it certainly eliminates billboards... But was the problem billboards, or was the problem billboardplacement? Was the problem billboards, or was the problem billboard size? If all billboards are banished, will advertisers turn their efforts on TV and radio advertisements, and is the resulting increase in those sorts of advertisements better or worse than viewing the horizon in a more billboard-free world?

More importantly, how will you now choose to educate yourself about the available goods and services in your area now that you cannot see any billboards?

What how does the billboard-banning policy address these issues? Simply, it doesn't. It never intended to. The whole problem was made up in the first place. How could we expect a solution to a made-up problem to ever fully compensate for the change in consumer landscape that results in the new policy?

Assumption Number Three: The Research Behind the Policy is Credible
I hate to burst your bubble, but government research is conducted by interns with bachelor's degrees in political science whose first exposure to the issue is the fact that they have been tasked to research it. They do an internet scan for articles on the topic, they compile a series of notable quotes and citations, they write an executive summary, and they pass it on.

The document they produce becomes the foundation for a policy that lasts over one hundred years. The only time these documents are ever "questioned" is when some competing bureaucrat wants to replace Billboard Ban X with Billboard Ban Y. Assumptions Number One and Number Two are never questioned, ever. Assumption Number Three is made to look appropriate for the time at which it was made. It is subsequently replaced by Assumption Number Three-Dot-One, but the ban persists.

Who are these people and what do they know about horizons or billboards? Or consumers and advertising? They are no one, and they know nothing. They are your cousin, Tuck, who did his Master's Thesis on feminism in Latvia. That's all there is to it.

Assumption Number Four: Bureaucrats Are Experts
You might love your cousin Tuck, and Tuck probably loves you, too. But in his capacity as a bureaucrat, all Tuck knows is that someone asked him to do some research, and he did it. He did the best he could. If he keeps doing a good job, one day he will be the person who asks for the research to be done: He will be Tuck's Manager.

Tuck's Manager oversees a government program tasked to regulate the four feet on either side of any state road. Tuck's Manager also wants to do a good job, and that good job consists entirely of ensuring that she knows what's happening on the four-foot strip at either side of any road.

How do issues come up? Innocent people who own a roadside farm decide they want to put up a billboard and rent it out. They become aware of the agency run by Tuck's Manager, and they send an email or place a phone call, or have their lawyers do it. In their email, they declare their intent to erect a billboard and ask what the licensing requirement is.

Tuck's Manager asks Tuck to find out. Tuck finds out that there is no licensing requirement. Tuck's Manager raises the issue at the next inter-departmental meeting, saying something to the effect of, "One of our constituents wants to erect a billboard. Now, if someone wants to erect a billboard, there currently is no licensing process in place for them to be able to do that, and so we would like approval to put together a fact-finding team to investigate the feasibility of implementing a licensing structure..."

As you can see, Tuck's Manager wants to help. In helping, Tuck's Manager succeeds only in taking the previous condition, which was liberty, and turning into a convoluted regulatory trap.

Thus, virtually all government growth and bureaucratic hells are created by the relatively innocent intentions of people who think that a formalized process is preferential to perfect liberty.

Assumption Number Five: The Government Agrees With Itself
What happens next is nothing more than the competing interest of agencies. At some point, during a future inter-departmental meeting, the manager of the Agency That Deals With Fields realizes that the billboard licensing process encroaches on his territory. So he now launches a fact-finding team, which asks some research of Johan; Johan discovers that birds occasionally smack into billboards at dusk, and the Bird Protectorate Agency doesn't much like what billboards to for birds.

So the Bird Protectorate Agency asks Simon to do some research and Simon discovers that 6 motorists out of 11 prefer looking at birds on the horizon to birds sitting on top of billboards. A stakeholder solicitation occurs and the findings reveal that the birds are beside the point; people prefer horizons to billboards.

The Bird Protectorate Agency coordinates with some other agencies to launch a regional campaign to eliminate the licensing of future billboards. By now, Tuck's Manager is running for mayor, promising to end the scourge of billboards forever.

Stop the Madness
Anything can become a complex issue if it changes hands enough times. The way to combat the perpetual loss of our liberties is to refuse to allow such nonsense to take any forward steps. Kill the inertia. There is no problem. Billboards are fine. Health care is expensive, but we all buy it. There is no problem, we just have preferences. We always prefer fun to work, so any issue that is presented as a choice between fun and work is a no-brainer.

2011-09-19

Today I'm adding two new additions to the Stationary Waves Lexicon. These items are related, and have been making me laugh to myself lately.

We can call them jointly The Spider/Bunny Effect.

Although a few of us really like spiders and find them fascinating - and it's true, they are fascinating - the vast majority of us have a tendency to get somewhat creeped-out at the sight of a spider. This reaction isn't entirely fear-based, either. People who aren't afraid of spiders at all still get startled or grossed-out at the sight of a spider, and I submit that anyone, regardless of their fondness for spiders, gets creeped out when a spider lands or crawls on them. This is the Spider Effect.

By comparison, we have the Bunny Effect, which is our bizarre tendency to want to grab, pet, love, feed, etc. bunnies for no apparent reason. Think about it: rabbits have virtually no practical use to humans, other than as a food source. But our reaction to the sight of a bunny isn't hunger, it is endearment. For some reason, no matter who we are, we all want to love little, fluffy, hopping bunnies simply by virtue of the fact that they are bunnies.

While I can perhaps make some sense out of the Spider Effect, reasoning that evolution has lead us to abhor things that are potentially venomous, I can make absolutely no sense of the Bunny Effect. What would make us fall in love with something small, fuzzy, and vegetarian? It seems almost random.

And yet, agree or disagree, we are all governed by the Spider/Bunny Effect to some extent or another...

2011-09-16

As I mentioned the other day, my experience on the insulin pump put me at odds with my health care team. The experience has left me a changed man. The "discussion" I had with members of my health care team certainly resembled an argument. I feel terrible about this, not because I argued with people who only had good intentions, but rather because the beliefs of my health care team (at least with respect to the pump) seem to be so at-odds with my body and my needs. The point is that I should not have to fight so hard to return to a therapy that worked for me, that made me happy. It made me realize that our health care system wants for individual care.

Having a great deal of exposure to all sides of the health care system both professionally and personally, I am aware of the guidelines and recommendations published by organizations such as CADTH, whose objective is to minimize public health care expenditure. It seems to me that there is a direct conflict of interest between any health care practitioner engaged in "cost-minimization" and the health care needs of the patient. The question of what is the most (statistically) cost-effective treatment path should never enter into the doctor's mind, if the doctor is to be truly medically objective.

The lone goal of a health care practitioner should be to exercise their personal judgement regarding what the best treatment is for the patient, and to communicate to the patient what that treatment is, and how it compares to the viable alternatives. If not this, then what is health care?

For all the yammering against the profit motive in health care that goes on out there, I would rather my doctor base his or her decisions on what is best for them individually than I would have them base their decisions on what's good for the faceless bureaucratic system. I am a patient. If the system does not deliver optimal care to me, then the system must be changed. All any of us should care about is whether we obtain the best health care we are capable of obtaining. All else is politics.

It's voting season in Ontario. For the benefit of my American readers, what this means is that volunteers (or employees?) of the government (and I'm not clear if it is the provincial or federal government) go from door to door writing down the personal information of the eligible voting public. This strikes me as being rather disturbing, but of course most people will excuse this as nothing more than an important safeguard against voter fraud.

In reality (in my opinion) it is the election itself that is somewhat fraudulent. Each Ontarian is asked to vote for the candidate who best represents their own personal views. The problem is that no one much cares what the candidates' views are. The candidates' views are irrelevant. What is relevant is the party to which the candidates belong. One Liberal, or Conservative, or Green, or Whatever does not appreciably differ from the others. Theoretically, they do, but the reality is that party members always vote the same way in Parliament. This is not a matter of opinion or perception, it is the reality of it. While it may be true that a particular Conservative may hold a slightly different viewpoint on, oh, let's say business licensing, than another Conservative, when voting in Parliament, the party risks "control" if their individual MPs vote according to their individual beliefs.

In this respect, Parliamentary systems differ crucially from Congressional systems. In Congress, congresspeople vote according to their individual beliefs, which tend to align with a particular party. In Parliament, what the leader of the party says, goes for the entire body of MPs for that party.

Given that fact, as I look around at every street corner in the city, I have to ask: What is the point of all these political signs? Everyone in Ontario is going to vote for the party of their choice, and they already know who the parties are. There may be some benefit to a very new or very small party to advertise, in case some voters are unaware of the party. Specific signs for specific candidates, however, are completely unnecessary.

This is particularly ironic in the case of the Ontario Green Party, papering the province with political billboards that deplete valuable natural resources, fill our swelling landfills, and further contribute to water, air, and land pollution and deforestation.

2011-09-12

I was moving over the last few days, which should explain my relative silence during that period. I have many exciting updates to provide, each in their own due course. The first of which appears right now!

My Experience With an Insulin Pump

After less than a month (and a little bit of arguing with my health care team), I have put an end to my insulin pump therapy. Given that this is in part a diabetes blog, and that I have written extensively about my experience with diabetes, providing recommendations to others from time to time, I feel somewhat obligated to put some thoughts down regarding my experience with the insulin pump.

First of all, I have to say that I think insulin pump therapy is right for some people. I do not think it is "all bad." Who I believe should be on the insulin pump is something I will get to in a moment. First, I would like to describe my own experience in detail.

My experience on pump therapy began the night before I was attached to the pump. Because it would be dangerous to use a pump while there is long-acting insulin in one's system, I had to forego an injection of Lantus the night before. My blood sugar skyrocketed to my highest-ever reading on record (post-diagnosis). I felt terrible. Having blood sugar that high is never safe, and I felt that my body was in real danger.

At any rate, I made it to the diabetes clinic in one piece the next morning and began my pump therapy. My nurse thought it prudent to initiate therapy with a basal rate equivalent to about 10 units of insulin per day. By the time I ended my pump therapy, I was on 14 units. For those of you unfamiliar with basal insulin, let me tell you: those four units make a huge difference! The fact that I had to titrate up over such a long period of time really discouraged me during the first couple of weeks of therapy. In my opinion, starting me off on such a small amount of daily insulin was the wrong decision. My blood sugar was high all the time.

At long last, I became fed up with having high blood glucose levels all the time, and I embarked on a somewhat reckless path of going for a 15 minute walk in the morning while my body still contained active bolus insulin from breakfast. I did this again in the afternoons, after lunch. Two 15-minute walks (very brisk), followed by a heavy workout in the afternoon. After weeks of being unable to work out due to high insulin levels and a general "run down" feeling, I brought my average daily blood glucose reading down from over 11.0 mmol/L to under 8.0. That's significant! It was also a lot of work.

On top of that, a major part of the drop in average blood glucose was due to repeated daily hypoglycemic or near-hypoglycemic events. I had finally achieved somewhat normal blood glucose readings, only to discover that my diabetes was out-of-control. I felt low all time.

Then, on one bad night, I unexpectedly dropped from a BG reading of 6.9 to one of 2.5 in twenty minutes. For my body and my diabetes experience, this is unheard of. It was the most horrible, violent hypoglycemic event I have ever had. I felt like I had reached the bitter end. When it was finally over, I couldn't get it out of my head. I was terrified of exercise, scared to take my mealtime bolus, worried that any small level of physical activity would plunge me deep into a coma. This was not entirely a fear-induced state of mind. Simple, every-day tasks like shopping at the mall or packing boxes were enough to send me into a low. This may be the experience of some diabetics, but prior to my going on insulin pump therapy, it was not my experience.

To make matters worse, I couldn't exercise. I tried running, by the pump would send me low every time - even if I disconnected it entirely. If I did both strength training and cardio, I would have a guaranteed low. If I only did one or the other, I wouldn't be in shape. My physical fitness deteriorated. Aiding in that process was the fact that simple foods like fruits and fats were wildly unpredictable on the pump for me. One banana - less than 30g of carbohydrates - would spike my blood sugar over 16 mmol/L even if I accounted for it perfectly. Sandwiches became a problem. Fatty foods became a problem. In short, eating became a problem. The only foods that were in any way predictable for me were whole grains and dairy products. Don't get me wrong, I think both are important parts of a good diet, but humans need vegetables and fruits.

My diet was deteriorating, my fitness was deteriorating, and my blood glucose was out of control. At long last, I contacted my health care team and told them I was ending my pump therapy once and for all, and returning to four-a-day injections of Lantus and Humalog.

At Odds With My Health Care Team

When I informed my team about my decision to return to daily injections, they literally argued with me for nearly two hours.

I tried to explain to them the following:

I was experiencing higher highs and lower lows than ever before. In particular, the lows were deep, dark, and evil and I was starting to become afraid of them.

Food was unpredictable on the pump.

Exercise was unpredictable on the pump.

My average blood glucose had not improved beyond pre-pump levels.

Being on the pump was a hell of a lot of work.

My pre-pump therapy was working for me.

Considering those facts, I could no longer see the benefit of remaining on the pump. If something works, and you have a chance of experiencing a small improvement at a great inconvenience, the marginal benefit is extremely low. This was and is my belief regarding the pump.

Could I have further altered my behavior and tweaked the pump in such away to capture even better control of my blood glucose? Yes, I think I could have. The problem is that my whole lifestyle was changing from being an active, healthy man with a good diet and an excellent attitude toward diabetes, to being a man who hardly exercises, eats poorly, and lives in constant fear of a severe hypoglycemic event, or else running blood sugar so high that I might as well not be taking any insulin at all.

I don't want my lifestyle to change. All I want is blood glucose control. I can get it on injections. To get it on the pump would require a lifestyle change I'm not prepared to make. My BG would improve, but every other bio-marker I have, from cardiovascular health to digestive tract health, would worsen. Who wants that?

My nurse and dietitian, however, remain convinced (as far as I can tell) that I simply hadn't had an adequate "adjustment period." According to them, short-term periods of high blood sugar "are not a problem." They tried to convince me that a lot of people like me have better control on a pump, that I can avoid injections, that things will be better once I get through the adjustment period.

To that, I have the following replies: First, I don't dislike my injections. They honestly don't bother me. They aren't painful, and I don't feel like a social outcast injecting before meals. Second, my diabetes wasn't out of control on injections. If I really struggled to maintain blood glucose control, I could see their point; but I'm fine on injections, so why bother?

Thirdly, though, is something very important...

Health Care Practitioners Don't Get the Full Story

Since my diagnosis, I have been accosted by doctors, nurses, educators, experts, interns, students, pharmaceutical marketers, and all other kinds of diabetes "stakeholders." Every conversation with each of these people has lasted about fifteen minutes on average. Fifteen minutes speaking with any one person, and then it's rush, rush, rush, off to the next health care practitioner. No one sits down and explains things medically. No one is interested in the complicated questions or any kind of individual care. No one seems to have time.

Therefore, the only one getting the full story is me. I'm the only one who hears from one person that "running high blood sugar in the short term is no big deal," and from another person that "diabetic retinopathy isn't caused by high blood sugar, but rather by large swings in blood glucose."

One person tells me to check my blood sugar no less than five times per day; when the next person hears that I am obeying the orders of my doctor, they say, "Wow, you test a lot! You should be on a pump!" One person tells me that I'm in an "adjustment period," the next person tells me I need to change the course of my therapy radically.

At all stages of the game, health care practitioners are attempting to steer me into the one path approved by "guidelines." Individual choice? Individual care? Individual experience? Forget about it.

This is a systemic problem. It's not the doctors' "fault." They are handed guidelines, and so they make use of them. This is the way the system works. They are doing things exactly the way they know how.

The problem is that if you are someone like myself, who doesn't fit into the box, you end up being at odds with your health care team, which is not a comfortable place to be when you have a serious, chronic illness.

Conclusion

Well, I have written a lot about this today. I plan on writing more later. My experience on the pump has taught me the value of patient advocacy, and I am considering becoming a more active member of my local chapter of the Canadian Diabetes Association. But we shall see.

Until then, I'll stick on my injections.

By the way, all's well that ends well. The day after returning to Lantus/Humalog therapy, my blood sugar stabilized. I'm back to eating normal, healthy food, and I can even run again. In short, I feel great. This is the therapy that works for me. If you're a diabetic, always make sure you do what's comfortable for you.

2011-09-08

At the risk of sounding a tad controversial, I would like to propose that we not commemorate the anniversary of the 9/11 terrorist event. Absolutely nothing good can come of a nation that chooses to remember its gravest sadness. While it is noble to pay tribute to our lost loved ones and the lives they lead, commemorating the mass destruction that plunged the world into the fear-ridden black hole it has become in the last ten years is at best macabre and at worst insane.

Consider every other major American political holiday: President's Day, Columbus Day, Independence Day, Martin Luther King, Jr. Day, etc. (I have chosen to leave out Memorial Day and Labor Day because these are not uniquely American holidays.) Each of these days commemorates something that makes the United States a wonderful place: our independence, our spirit of discovery, great men in our history, and so forth.

It is natural for a nation to commemorate its heroes and its greatest achievements. Maintaining such a commitment propagates a general spirit of optimism and pride. Yes, such days are deliberately nationalistic and as such contain an element of propaganda. However, it is at least a type of propaganda that speaks to our greatest qualities as a nation: freedom, ambition, equality, leadership.

Commemorating a day of death and mass destruction serves no other purpose but to remind us that horrible things can happen to us, that we have gone to war against a faceless, nameless, and largely uncoordinated group of petty criminals who attack civilians in order to protest against the acts of our federal government.

9/11 as a "holiday," as a symbol of national memorium, is designed to keep us at war. That is the plain truth of it. The government seeks only to remind us that something nasty can happen to us at any minute. Orange alert! Orange alert! Keep an eye on your neighbors, keep a gas mask in the pantry, pay no attention to the unconstitutional body-scanners and the ever-climbing national debt, inflation rate, and barriers to trade.

Only through fear, shame, and sadness can tyrants rule us. Freedom and optimism walk hand-in-hand.

2011-09-06

I'm happy to report that I have marked improvement again this week. I've managed to bring Hell's Effervescence up to about 120bpm, while my continued work on Sextuplet Time and Strung Out have brought my speed on those exercises up to 88bpm and 138bpm, respectively. Recall that my original goal for Strung Out was 150bpm, so I am getting closer all the time. (My pie-in-the-sky dream for Sextuplet Time remains awfully elusive at this point, however.)

This week, I'd like for us to work on our groupings. These next two exercises seem simple at first, but getting the tempo and feel right can prove to be a challenge at higher speeds.

Exercise 4: Merge Without Blocking Traffic
We've all had to merge onto the freeway. The ramp is small, and we have to get up to speed quickly, but the real test of good driving is whether we can, once up to speed, merge into heavy traffic without slowing down or causing anyone else to slow down.

In the spirit of that disjointed, two-part endeavor, I have created Merge Without Blocking Traffic. The exercise is rather straight-forward. We begin with a 16-note ascending pattern. Once finished, we change time signatures to 3/4 and descend in the same note pattern via sextuplets.

Repeat this pattern two times, and two times only, then reverse the orientation. During measure #5, we stay in 3/4 and ascend in sextuplets, changing the fingering slightly to accommodate the rhythm. Then, we descend in a 16th-note pattern.

Obviously, what's tricky about this one are the transitions. Here's what it looks like:

Exercise 5: Balance Beam
I call this next exercise Balance Beam because when one walks along a balance beam, it's not difficult at all... at first. A few steps later, you find you leaned a little too far to the right and have to compensate by leaning left; this again requires compensation by leaning to the right again. What was at first easy quickly spins out of control. One false move, and you lose your balance entirely, tumbling off the beam.

Similarly, the trick to this exercise is ensuring you never get too far ahead - nor too far behind - the beat. If you don't play it exactly, you may never catch up to the point where you're back "on" the beat. You'll have to start over.

The idea is this: play the world's most over-played 16th-note runs... but play them as sextuplets. Easy in principle, but a real challenge if you're gunning for accuracy.

Playing this exercise accurately at high speeds is one of the most impressive licks you'll ever master. I admit: I stole the 2nd measure from the guitar solo in Extreme's Get the Funk Out. While that solo gets a lot of attention for its near-impossible tapping arpeggios, this forgotten lick is the type of thing that sets people like Nuno Bettencourt and Warren DiMartini apart from the rest of the 80s guitar crowd.

Make sure you play the hammer-ons and pull-offs. Picking those notes is cheating. You'll cover up your mistakes with the sound of the pick attack. Mastering this as a combined legato-staccato lick is when you'll know you've really got it.

I'd like to remind my readers that the United States of America, among many other nations, is currently engaged in war .It seems incomprehensible, but I believe we have now been at war so long that people no longer consider it an important part of their daily business. That the US government is actively engaged in spending money for the purposes of killing enemy combatants is hardly a second thought in the regular thoughts of most of us.

And yet, in my opinion, it is extremely important that we continue to understand that ours is a nation at war. At war. Killing people.

The liberal critique of the argument in favor of war is fundamentally different from that of the humanitarians. It starts from the premise that not war, but peace, is the father of all things. What alone enables mankind to advance and distinguishes man from the animals is social cooperation. It is labor alone that is productive: it creates wealth and therewith lays the outward foundations for the inward flowering of man. War only destroys; it cannot create. War, carnage, destruction, and devastation we have in common with the predatory beasts of the jungle; constructive labor is our distinctively human characteristic. The liberal abhors war, not, like the humanitarian, in spite of the fact that it has beneficial consequences, but because it has only harmful ones.

The profundity of these observations cannot be overstated. Many Keynesian economists of Paul Krugman's ilk like to claim that World War II ended the Great Depression; they also like to cover up the fact that their prescription of "more government spending" in fact, in reality, in actuality renders itself as more money spent on war.

That government spending always feeds and propagates the war machine (or "military-industrial complex," or whatever the leftist professors are calling it these days) is a central tenet of the Misesian world view. A socialist government grows; war follows. This is a logical chain of events, to Mises.

It should come as no surprise to any of us, then, that we find ourselves in a world in which we stand on an ever-shrinking isthmus of civil liberty, with an ocean of war threatening to swallow us on one side and an ocean of socialism threatening to swallow us on the other.

But note in the quote above: War cannot create. It can only destroy what the free men and women produce during times of peace.

Mises goes on to write:

How harmful war is to the development of human civilization becomes clearly apparent once one understands the advantages derived from the division of labor. The division of labor turns the self-sufficient individual into the [political animal] dependent on his fellow men, the social animal of which Aristotle spoke. Hostilities between one animal and another, or between one savage and another, in no way alter the economic basis of their existence. The matter is quite different when a quarrel that has to be decided by an appeal to arms breaks out among the members of a community in which labor is divided. In such a society each individual has a specialized function; no one is any longer in a position to live independently, because all have need of one another's aid and support. Self-sufficient farmers, who produce on their own farms everything that they and their families need, can make war on one another. But when a village divides into factions, with the smith on one side and the shoemaker on the other, one faction will have to suffer from want of shoes, and the other from want of tools and weapons. Civil war destroys the division of labor inasmuch as it compels each group to content itself with the labor of its own adherents.

Mises at once provides an argument against both war and anarchy. Only through enduring peace can any of us organize our activities in a productive and beneficial manner. If the threat of war and instability lingers over our heads like a Sword of Damocles then nobody can ever really plan any kind of long-term business prospect.

Things have changed quite a bit since then. I've moved from an average blood glucose level of about 12mmol/L (very high) to just over 8mmol/L (getting there). My levels over the past few days have been consistent with my best-ever-controlled time period on record, which was early June of this year. So in terms of blood glucose control, my pump is finally starting to work.

In terms of lifestyle, however, I find that it took a lot of insulin to get me to where I am today. The unfortunate result of this is that I cannot be so fancy-free with the exercise. On Friday, I went for a 40-minute run and had to stop about two-thirds of the way into it and treat myself for hypoglycemia. I was packing boxes and moving all weekend long, and an extended period of packing or assembling furniture would result in a mild low.

So I guess step one is complete, step one being "get control of your blood sugar."

2011-09-02

I'd like to give my diabetic readers some deeper insight into how things are going on the insulin pump. Recently, I wrote that things were not going well. I have had the opportunity to do a deeper dive into the data I collect on myself, and I have discovered some rather interesting facts. [Note: I have alluded to this data collection tool before; it has proven invaluable. At some point I must make a workable version available to you, the readers.]

Part One: A Look at the Data
Have a look at the following revised graph of my daily average blood glucose readings.

I should add a few interpretive notes. First, I failed at data collection during June and July. I had too many other things going on. Second, the climb in August is owing to the heat wave and its impact on the efficacy of my Humalog. Third, yesterday's significantly lower daily average is the result of my dedicated effort to bring down my average blood glucose. I am getting an extra 30 minutes of walking in every day. That's significant.

Aside from the massive hole in available data during the months of June and July, something obvious stands out from this data immediately:

First of all, the "recent" 7-day moving average is not appreciably different from the "old" 7-day moving average. (This is the dotted-black line.)

Second of all, the daily average (purple line) from August 1st to the present shows two distinct trends. The first is a climb that peaks at August 16th, my first day on the pump. The second is not a descent per se, but rather an immediate drop to the 10-12 mmol/L range, which remains relatively flat from there.

Finally, and most interesting of all, is the fact that the median reading is now trending higher than the moving average, in contrast to my pre-pump data.

Part Two: Some Introspection

My daily readings are all over the place. As I write this, my blood glucose is low: 3.3 mmol/L, immediately following my morning 15-minute walk. Before breakfast, it was 13.5, and two hours later, it was 12.0.

Bottom line: I am experiencing wide swings in blood glucose levels on the pump. This is incredibly uncomfortable and puts me at greater risk of neuropathy. My average readings were about the same on 4 injections per day, but it sure felt like my variation from day to day was lower.

And yet, the standard deviation of my blood glucose readings both over the last month and over the last week are lower than the total variation across all readings.

So am I merely imagining that I am in a state of discomfort? Am I actually in the same place I was before? It's a real puzzle.

Part Three: Pump Yea or Nay?

All the studies suggest that insulin pumps produce better control over blood glucose. I can tell you that nearly three weeks into the pump, I can't figure the darn thing out. I feel like I'm high one minute and low the next. I never feel like I'm actually "normal." I don't know how to treat my lows, I feel like eating snacks has a bigger impact on my body now that I'm using a pump. It's impossible to find the right balance.

Although, undeniably, my blood sugar is in better control since August 16th, and the walks I'm taking during the day are definitely bringing my blood sugar down, which means that I have some control, after all.

Whether the pump truly produces better control or whether a pump simply requires a person to watch their blood sugar obsessively and tweak things accordingly is the question. Does a pump help, or does a pump simply force a person to become hyper-vigilant?